Fluctuating Relatively Low PSA Levels

[OhioGuy44]

Please evaluate the following PSA test results. I'm 63, with a birthday later this month. My FP wants me to have another PSA test next month.  2003 = 1.4; 2004 = 1.3; 2006 = 0.7; 2007 = 1.79; 2008 (March) = 2.7, with intercourse 36 hours before; 2008 (May) = 1.84 (fPSA = 11%).  My FP says that fPSA percent is not meaningful if total PSA < 4.0, but my next test is also to be an fPSA test. I have mild BPH symptoms that seem to vary a lot from week to week, and are also less after exercise. I play basketball three days a week.

I've also wondered if my PSA variations might correlated with my symptomology.  That is, am I more likely to have a higher PSA level when my mild BPH symptoms are more noticeable?  My anecdotal memories are that there may be a slight, but not consistent, connections here.  

I'm relying on my FP for testing and advice. I do medical writing for a living, so I've read a good deal about this issue in the medical literature. I'm curious how an independent, trained urologist might interpret my test results. I'm not using this as a substitute for my personal physician's advice, but only as a tool to learn more about this issue.  PSA test results I'm finding are very complex and are not easy to interpret, except in unambiguous cases.

Thanks for your help.

[OhioGuy44]

After about a year and half delay, I thought I would post additional test resutls

Nov 2008 -- PSA = 2.35; fPSA = 14%
Jan 2009 -- PSA = 2.33; fPSA = not done
April 2010 -- PSA = 2.20; fPSA = not done

Since for the last year and half my PSA has been stable, my FP says that there is no reason for a biopsy and plans to continue just annual evaluation at this point.  He seems to have concluded that I have mild BPH that has prompted the rise in my PSA over the last several years.  Make sense?  

Sorry for my delay in posting the results as they came in.  As always I appreciate your feedback.  This is a great web site.

[OhioGuy44]

Thanks very much for your thoughtful response. I really appreciate it.

[blueskyabq]

I read a lots about prostate and PSA test.  As I can tell, as your age 63, PSA 1.84 (05/08) seems good (low).  Your trend showed that 2006 to 2007 had a big step (0.7 to 1.79) because the velocity is 1.09, which >0.75/yr, but since that (03/08 will not count) is 1.84.  I think it seems that your "new" level is about 1.8, but this new trend need to be proved - if you repeat it in a couple years, and it will stay in this level.

Your BPH and aging will also increase your PSA, so did any possible infection and inflammation.  Sometime infection is not very obvious, but a course of antibiotics will take care of problems, it is up to your Dr to decide.  Also, sometime "unknow" reasons also cause PSA result fluctuated, if you feel it is not actual, just repeat it.  Some medical Lab provide "walk in " PSA test w/o Dr's order, it is worth for a little money ( about $30) to have a peace of mind.

As of %free PSA,  as I read, your right, for PSA <4, %free PSA related to cancer is not established, now only used for PSA=4-10. So total PSA is important as your PSA is <4.  Some alb may offer cPSA which direct measure bound PSA (related to cancer) but not measure total PSA and %free PSA, but most labs do not offer cPSA.

There is a book - The complete prostate book, by J. Stephen Jones from Cleveland Clinic Foundation, describe all prostate issues  and PSA test in details.

Good luck for your PSA test, hope it will stable.  And please keep us posted.

The best regards.